Acarbose for polycystic ovary syndrome

OBJECTIVE: To review the evidence for use of acarbose in the management of polycystic ovary syndrome (PCOS). DATA SOURCES: Relevant publications were identified through a systematic search of PubMed English-language literature (1950-February 2008) using the MeSH terms and key words acarbose and polycystic ovary syndrome. STUDY SELECTION AND DATA EXTRACTION: The literature search retrieved 6 primary literature citations. Three randomized controlled clinical trials and one open-label study were evaluated. The other 2 citations were not evaluated due to only a peripheral mention of PCOS in relation to diabetes. DATA SYNTHESIS: PCOS is a complex disorder presenting most commonly with oligomenorrhea or amenorrhea, infertility, hirsutism, acne, and obesity. Acarbose is a promising therapy for PCOS because of its effects on postprandial insulin levels. In multiple clinical studies, acarbose improved hirsutism, acne, and menstrual irregularities through reduction tin androgen concentrations and through increased androgen binding. When compared with metformin in women with PCOS and clomiphene-resistant infertitlity, acarbose induced greated weight loss and improved menstrual regularity and signs of fertility to a similar degree. Markers of cardiovascular risk were also significantly improved following 6 months of acarbose therapy in obese women with PCOS. Adverse effects, specifically gastrointestinal, were documented. Despite promising results, the studies were limited by small sample size and, in some cases, methods that were not clearly defined. CONCLUSIONS: Several trials have evaluated the use of acarbose in the management of PCOS with positive clinical evidence, but the results of these trails have benn corroborated by more rigorous studies.